Anesthesia and Perioperative Care
140.01: ADVANCED CLINICAL CLERKSHIP
- Seema Gandhi, M.D.
UCSF Department of Anesthesia & Perioperative Care offers a 4-week clinical clerkship to provide medical students a perspective on anesthesia resident training, didactics, & research opportunities. This rotation offers a unique insight into the depth & breadth of cases performed at UCSF. The clerkship includes rotating at three sites: 1) Moffitt-Long Hospital: a tertiary referral center for complex neurosurgical, cardiovascular, transplant, pediatric, orthopedic cases. One week is spent in the operating rooms & one week with the regional & pain management services. 2) San Francisco General Hospital (SFGH): the city hospital & level one trauma center. One week spent with residents on night call learning management of trauma care & acute resuscitation. 3) VA Medical Center: One week of cardiac anesthesia.
I. Acquire the following skills and knowledge:
- Describe preoxygenation and develop the ability to mask ventilate a conscious and unconscious patient.
- Learn techniques of preventing airway obstruction in the conscious and unconscious patient.
- Describe the anatomic or physiologic characteristics that describe a patient who has a difficult airway.
- Conduct a preoperative patient interview and physical.
- Describe the indications/complications for the following procedures: blind nasal tracheal intubation in the conscious patient, orotracheal intubation in the unconscious patient using direct laryngoscopy, cricoid
- Pressure and mask ventilation of the unconscious patient.
- Describe the components of anesthesia: amnesia, analgesia, muscle relaxation, control of ANS, sedation.
II. Anesthesia and co-existing diseases.
- Identify the significant diseases that will impact patients morbidity/mortality.
- Assess the adequacy of medical control of pre-existing conditions.
- Anticipate intraoperative requirements for monitoring and drug therapy.
- Predict perioperative risk based on pre-existing disease and the surgical procedure proposed.
For each system:
- Cardiovascular: (ie., Coronary artery disease, congestive heart failure, valvular heart disease, arrhythmias
- Respiratory: (ie., Upper respiratory infection, asthma, COPD)
- Gastrointestinal: (ie., Risk for aspiration, electrolyte imbalance)
- Endocrine: (ie., Diabetes, thyroid, adrenal)
- Neuromuscular: (ie., Burns, umn lesions, LMN lesions, trauma)
III. Pain pathways/perioperative pain management.
- Understand mechanisms of pain; both acute and chronic.
- Know how to prescribe appropriate medications for patient-controlled analgesia (pca).
- Learn the methods available for providing analgesia for the post-operative patient.
- Differentiate between pain syndromes which require �specialist� evaluation vs. Those which may be effectively managed by primary care physicians.
IV. Anesthesia and concurrent drug therapy: (ie., Psychotropic, anti-arrhythmias, anti-hypertensive, anti-anginal, aspirin/nsaid)
V. Special monitoring / technical procedures. (ie., Starting iv's, measuring bp, a-line, capnography, oximetry)
VI. Blood therapy and maintaining appropriate fluid balance.
- Realize the difference between different types of iv solutions.
- During blood loss, appreciate the difference between anemia and hypovolemia.
VII. Operating room hazards:
- Positioning: understand the factors which make anesthetized patients more susceptible to peripheral nerve injuries.
- Hypothermia: etiology, prevention and treatment.
- Rare event: malignant hyperthermia, aspiration pneumonitis
VIII. Acid base repair and maintenance:
- To understand the causes and consequences of acid-base disturbances and how to analyze acid-base abnormalities.
- To know the causes of hypoxia.
- To understand 02 transport and measure it's adequacy.
IX. CPR: to review the principles behind basic and advanced CPR with regard to:
- Time of institution of CPR measures.
- CPR organization
- Airway support
- Physical cardiac support
- Therapeutic support
X. Recovery from anesthesia:
- Assess emergence from anesthesia
- Assess criteria for tracheal extubation.
- Understand common problems in the recovery room
- Learn about oxygen therapy and the equipment used to deliver it.
Wide range of management issues for both children and adults.
Recommended Text or Reading:
Clinical Anesthesiology by Morgan, Mikhail, & Murray, 4th edition. A Lange medical book.
Work closely with anesthesia faculty, fellows and residents.
Patient Contact Hour Number (hours):
Classroom Time (hours):
Outside Study (hours):
Three weeks of M-F daytime. One week of evening and nighttime (off during the day).
2 weeks of Anesthesia experience or completion of Anesthesia/Medicine & Surgery core clerkship.
Quarters Taught: Su 1 & & 3, Fa, Wi, Sp
Minimum Weeks Offered: 4
Maximum Students per Block: 4
Contact Name: Marie Lim
Contact Phone: (415) 476-2851
Location to report to: You will be notified
How to Add & Drop a course:
To add or drop this course, please submit a request through the online elective request system.